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As Originally Printed in Tanning Trends magazine

January 2002

Determined To Defend Vitamin D

Dr. Michael Holick took a big step forward in 2001 in making the case that
sun-induced vitamin D is critical to human health.

He stood there, again, on the ballroom stage in Nashville in front of hundreds
of indoor tanning facility operators, for the sixth year in a row playing a
major part in Smart Tan’s educational conference.

He is Boston University’s Dr. Michael Holick – perhaps the world’s leading
researcher touting the belief that humanity, in its recent obsession over fitness
and preventative medicine, has overlooked the importance of one particular vitamin
- the human hormone sometimes called “The Sunshine Vitamin.”

We know it as vitamin D.

So Holick stood there again Oct. 25 in Nashville, reviewing what he has deemed
“The Good, The Bad and The Ugly” about ultraviolet light. Many in
the audience have heard him speak several times before – three, four or even
five times. For any other speaker, that’s a recipe for yawns. But the indoor
tanning industry soaks in Holick’s material each year, and Holick pours an increasing
amount of energy and excitement into his talks.

And this year the tanning industry had something to be excited about. Holick
is on the verge of publishing the results of research the tanning industry funded,
confirming some long-believed theories about indoor tanning and vitamin D production.
Call it the first giant step in the tanning industry’s new effort to mount data
in support of the positive effects of ultraviolet light.

“We think that in general the population is in risk of vitamin D deficiency
chronically at all ages,” Holick said. “Only by having adequate exposure
to sunlight or taking much more vitamin D will you satisfy your vitamin D requirements.”

Holick is the director of the General Clinical Research Center at the Boston
University School of Medicine – a lofty, credible position in the research community.
He also directs the school’s Vitamin D, Skin and Bone Center. He is perhaps
the world’s most respected photobiologist who believes that the benefits of
regular sun exposure received in a non-burning fashion outweigh the risks.

The lack of vitamin D, and what that deficiency can lead to, is Holick’s main
concern. Bone diseases such as osteoporosis and osteomalacia are linked to vitamin
D deprivation, and researchers this year have uncovered the mechanism by which
vitamin D plays a role in the prevention of breast, colon and prostate cancers.

That discovery has Holick very excited. “The dermatology community is
beginning to rethink this issue,” he explained. “It has been a long
and tough battle in trying to have them appreciate that there are some beneficial
effects to the tanning process and being exposed to sunlight.”

To make his case, Holick had to attack some pretty established preconceived
notions about ultraviolet light. “I think many dermatologists don’t understand
it. They have pseudo-information, and as a result it is easy for them to stick
their heads in the sand and say that ‘That is our policy: No exposure to sunlight
and always wear sunscreen. End of story.’ They don’t appreciate the potential
health consequences of that.”

But now he believes he is turning the corner in getting people to recognize
his work and the work of others who believe in the positive effects of sunlight.
The U.S. Food and Drug Administration, for instance, is watching his work very
closely. “I think that more of the research dermatologists – those that
are really in the forefront of dermatology – are finally getting the message
that I have been trying to get across for a long time that maybe there is in
fact a benefit. And that we really need to look at both sides of the coin, that
it is not simply black and white that you should not have any exposure to sunlight
or tanning bed radiation.”

Holick’s New Research

Dr. Michael Holick presented preliminary data on three studies he completed
this year at Smart Tan’s educational conference at the ITA Indoor Tanning World
Expo. Holick first proposed these studies in 1999 and approached the tanning
industry for financial support for the project. Smart Tan did much of the early
legwork, and funded 38 percent of the project. The Indoor Tanning Association
- formed in 1999 to fund research and promotional efforts for the industry -
made completion of the project funding possible, by funding 62 percent of the
effort.

“Tanning bed exposure has both benefits and potential harmful effects
if not used properly,” Holick says. “The concept that Smart Tan is
trying to get across is a very good one. That is, that if you want to tan, you
should tan properly and intelligently and you should never, never burn.”

Here is a glimpse at what Holick will be publishing in peer-reviewed medical
journals in the coming months from research conducted with funding from ITA
and Smart Tan:

1. UV Light Treats Osteoporosis

Holick has submitted a paper to the Journal of Gastroneurology summarizing
a case study completed with funding from ITA and Smart Tan. The study is of
a 61-year-old woman who came to his Vitamin D clinic who was severely vitamin
D deficient and showed signs of significant bone decay consistent with osteoporosis.

“It was so severe when she came to my office she couldn’t sit down, she
was in tears because all her bones ached so much,” Holick explained. “So
what do you do? Tanning beds to the rescue.”

Using the tanning equipment donated to Holick by Tan America and puretan as
part of the ITA study, Holick exposed the woman three times a week to tanning
bed light, following the recommended exposure schedule for her skin type. The
woman’s condition improved significantly.

“The bone pain over several months gradually dissolved, and the vitamin
D level increased by 700 percent, just by simply being exposed to tanning bed
radiation,” Holick explained.

Osteoporosis is a greater problem than many people realize. More than 25 million
Americans suffer from osteoporosis, 20 million of whom are women. This debilitating
disease usually leaves a person stooped over, and their activity is severely
limited. Vitamin D deficiency also can cause osteomalacia, a mineralization
defect that causes intense pain.

However, vitamin D alone isn’t enough for good bone health; calcium helps the
body absorb the vitamin. Dr. Holick’s recipe: Calcium plus vitamin D plus exercise
equals good bone health. Without vitamin D, the body can only absorb 10 to 15
percent of the calcium it does when healthy vitamin D levels are present.

Holick’s case study should be published in the next few months.

2. Tanning Bed Light Is a Good Source of Vitamin D

For years Holick has talked about the theory of “Vitamin D Winter”
- a term he coined describing the fact that there is not sufficient UVB outdoors
from November through March in the Northeast for a person to even produce vitamin
D.

This may explain why so much of the population is vitamin D deficient. In 1998,
Holick published a paper in the medical journal The Lancet showing that 41 percent
of hospital patients at Massachusetts General Hospital were vitamin D deficient.

Since that time, with funding from ITA and Smart Tan, Holick has compiled data
on another group of chronically unexposed people: his own medical students,
whose studies leave them little time outdoors at all. “These are people
who never see the light of day,” Holick explained.

Sure enough, 41 percent of his medical students were vitamin D deficient. But,
upon exposure to the tanning beds in Holick’s lab, the condition was corrected.
Holick will be publishing a paper on this data in the near future. “It
will show that tanning is a very effective way to maintain your vitamin D status,”
Holick said.

His work with the medical students also produced some other results. Using
a flash spectrometer purchased by Smart Tan, Holick was able to “measure”
and chart the progress of the students’ tans. Two hours after tanning, the group
showed immediate pigment darkening – a 2-3 percent increase in pigmentation.
Within 48 hours, melanin content increased up to 40 percent.

Holick believes there may be a link between melanin production and vitamin
D production. This data will help him explore that theory.

3. Studying UV Light and DNA

Studying the intercellular activity of tanned skin cells is a field Holick
is pioneering. In the mid 1990s California Tan purchased a specialized $100,000
confocal microscope for Holick that helped him gaze into individual live skin
cells as they tanned and explore this field for the first time.

Now ITA and Smart Tan have leased Holick a $100,000 genetic testing machine
that will help him measure gene expression, DNA repair and chart the role vitamin
D plays in the regulation of cell growth. He is closely monitoring a substance
known as TGF beta which is believed to regulate cell growth. This is particularly
important, given work that now suggests vitamin D may play a role in the prevention
of breast, colon and prostate cancers.

“We are now in the process of trying to understand how that impacts skin
health and disease,” Holick said. “We are now in the process of analyzing
our data.”

Clearing the Anti-Cancer Picture

Holick and other photobiologists are excited about new work this year that
appears to have unlocked the puzzle of why sunlight exposure is linked to lower
risks of many internal cancers. The research community has known since the 1940s
that prostate, colon and breast cancers are less common in sunny parts of the
world. While vitamin D was suspected to play a role in this, nobody understood
exactly why until this year.

Vitamin D produced from sun exposure is activated in the body in the liver
and kidneys. “The activated form does something else very important. It
tells your cells to grow properly. Activated Vitamin D inhibits cancer growth.”

But researchers this year discovered something new that explains this relationship.
“Breast, colon and prostate cells all activate vitamin D. That is a new
concept.” We now realize that not only does your kidney make it – but your
colon, breast and a lot of other tissues make it as well, This is a likely explanation
for the sun-cancer connection.”

That has Holick wondering if recommendations for vitamin D intake – which are
based on maintaining bone health – should be reviewed. “There may be two
levels of vitamin D deficiency – one for bone health, and one for cellular health,”
he explained.

Turning to the Sun

Holick’s work in the mid 1990s showed that there is no reliable source of vitamin
D in our diets, that vitamin D levels reported on milk cartons are overestimated
half of the time and that 15-20 percent of milk has no vitamin D content at
all. That leaves sun exposure and vitamin supplementation as the only alternatives.

Since it is not reasonable to assume that the entire population will turn to
vitamin supplementation, that puts sunshine back into play as an important source
of this important vitamin.

“With adequate exposure to sunlight, dietary vitamin D becomes unnecessary.
It is remarkable how exposure to sunlight a few times a week can reduce the
risk of osteoporosis, osteomalacia, muscle weakness, fractures and maybe some
of the common cancers, but also induce a sense of well-being.” Holick wrote
in an article in The Lancet earlier this year.

And Holick is determined to get that message to the masses.

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